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Women in UAB Cardiology provide healing and promote hope

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As the UAB Heersink School of Medicine observes Women's History Month, it offers all, no matter what gender identity, an opportunity to recognize the many women who have made important contributions to medicine and science. Rebecca Lee Crumpler, Dorothy Hodgkin, Katherine Johnson, Virginia Apgar, Marie Maynard Daly, and many more achieved significant firsts that paved the way for women today to follow in their footsteps.

The Office for Diversity and Inclusion has partnered with the Department of Medicine to highlight the exemplary work of pioneering women in the school today, like the all female-team of cardiologists who are forging a new specialty field bridging heart health and cancer care.

In the 30 years since this national observance began, many cultural changes have been made as women fought for equal opportunity, equal pay, and equal respect for their work. Notably, the number of women enrolled in medical school has exceeded the number of men, with women making up 55% of the matriculants in 2021. But the ability of women to forge careers after their training, and to rise to equal proportions among leadership positions, has not advanced at the same pace.

This is especially notable in medical specialties like cardiovascular disease. According to the Association of American Medical Colleges Physician Specialty Data Report, only 14.9% of the practicing cardiologists in 2019 were female.

At UAB, this statistic is improving, thanks to many extraordinary women cardiovascular scientists and physicians. In particular, the UAB Division of Cardiovascular Disease recruited two cardiologists in 1977 who revolutionized the way we understand and manage high blood pressure: the late Harriet Dustan, M.D., and Suzanne Oparil, M.D.

Dustan helped develop or investigate all the early anti-hypertensive agents, changing hypertension from a death sentence to a treatable disease. Her research included the effects of serotonin in constricting blood vessels; the role of the blood enzyme renin; and the roles of sodium and obesity in hypertension. Dustan served as the second female president of the American Heart Association and was the first editor-in-chief of its journal Hypertension.

Dr. Oparil is a distinguished professor of medicine, a professor of cellular developmental and integrative biology, and director of the UAB Vascular Research and Hypertension Program. Her early work with angiotensin and angiotensin converting enzyme (ACE) inhibitors is another important underpinning of hypertension research, and her contributions as a principal investigator of the Systolic Blood Pressure Intervention Trial (SPRINT) Research Group redefined therapeutic targets for high blood pressure in 2015.

Today, the division is home to a dozen women cardiologists, including an all-female team who is breaking new ground in cardiovascular care. They specialize in the emerging field of cardio-oncology, a focused approach to help patients whose cancer treatments have led to cardiac complications.

Carrie Lenneman, M.D., directs the Cardio-Oncology Program in UAB Medicine’s Cardiovascular Institute, working together with Riem Hawi, M.D., Garima Arora, M.D., Efstathia Andrikopoulou, M.D., Courtney Estes, CRNP, and Abby Misdom Johnson, R.N. Though the program just officially launched in 2018 with a single provider, the team has grown to 6 providers who have already received Gold Standard accreditation from the International Society of Cardio-Oncology.

While certain cancer treatments cause cardiac problems during cancer therapy, others may show up much later, such as high blood pressure, abnormal heart rhythms, heart blockages, blood clots, and stroke. In fact, the second most common cause of death in cancer survivors is heart disease. Cardiologists work hand in hand with cancer specialists within the O’Neal Comprehensive Cancer Center at UAB to identify any potential cardiac side effects from cancer treatment and treat or prevent them, when possible.

Lenneman first discovered her passion for cardio-oncology in 2008. “I fell into cardio-oncology by accident during a fellowship research project examining cardio-toxicity in breast cancer patients,” Lenneman explains. “As I enrolled participants into my trial, I realized that these women were conquering cancer only to be victimized by cardiac problems. I felt compelled to learn more and to contribute to the field via research and clinical care in cardio-oncology.”

Prior to joining the team, Estes served multiple years in both cardiology and oncology units at UAB. The combination of her two clinical loves provides meaningful interactions every day. She recalls the time a patient with a gastric tumor came to see her for cardiac clearance prior to surgery. “He could barely walk far, was fatigued and had many signs of possible coronary disease,” Estes remembers. She recommended a heart catheterization which turned out to be a crucial test, as it revealed her patient had multi-vessel disease and needed a coronary artery bypass graft.

While Estes was dismayed by the diagnosis and subsequent delay of the cancer surgery, she knew it was important to resolve the cardiac issue first. “It was the absolute way to go in order for him to safely get through his gastric surgery and have optimal cardiac compensation during the procedure,” she states. When she saw him on a return visit, he hugged Estes and told her that he felt like a brand new person. “He then was able to plan for his gastric surgery, and has done really well,” Estes confirms.

Johnson, the team’s registered nurse, also highlights how important patient relationships are in the specialty. “I love being a part of the Cardio-Onc team. Many of our patients have just received a life-altering diagnosis, and their world has turned upside down, so it’s very fulfilling when we can help relieve a little of their stress with our cardiology care,” Johnson shares. “I’m proud to work alongside such amazing physicians. The fact that we’re a team of all ladies is just the cherry on top!”

Lenneman emphasized that she didn’t set out to assemble an all-female team, but they each appreciate the unique environment. Hawi shared her perspective, “This is the first time I have worked on an all women’s team. In fact, I became a physician during a time in my life where my goal was to strive to mold into a traditional male phenotype. Now that I am in a different season, I appreciate working in a team of supportive powerhouses that understands some of the challenges and are ready to jump in to help without judgment.”

Andrikopoulou echoed their sentiments. “Working in an all-woman team feels extremely liberating and ‘at home.’ It allows me to bring my authentic self to work every single day.” Other team members pointed to the importance of supporting each other through the experiences of balancing family and career, saying that the team is close-knit and understands the struggles common to all women.

Working together through the stress and uncertainty of COVID-19 brought renewed attention to the issues of workplace gender equality. Hawi noted, “The pandemic has specifically intensified the multifaceted burden that working women/mothers were facing every day. Now that the brunt of the pandemic is hopefully over, it is time for healing our healthcare workers, and for addressing some of these inequalities as a society.”

Arora pointed to a recent study in the Journal of American Cardiology that describes particularly troubling statistics for female cardiologists who decide to have children. More than a third of pregnant cardiologists were required to take extra service or call before maternity leave; 41.2% experienced a salary decrease during that year; self-reported pregnancy complications occurred in 36.5% of those surveyed, and those with complications had a 60% greater chance of reporting that pregnancy adversely affected their career.

While these data suggest ongoing inequity for women in cardiology, the team remains committed to their patients and their academic medical careers. “Personally, I see and experience a cultural change in medicine overall, and I am hopeful that cardiology will ultimately catch up as well,” Hawi concludes.